Delayed surgery for high-grade acromioclavicular joint dislocations does not compromise clinical and radiographic outcomes: a systematic review and meta-analysis

Abstract

Purpose There is currently no consensus in the literature regarding the superiority of early versus delayed surgical management for acute high-grade Rockwood acromioclavicular joint (ACJ) dislocations. In particular, the clinical benefits and limitations associated with different surgical timings remain inadequately defined and quantified. Methods A systematic review was conducted using PubMed, Web of Science, and Embase databases in June 2024. Studies comparing early and delayed surgical interventions for acute high-grade Rockwood ACJ dislocations were selected. Outcomes were evaluated in terms of Constant score, Disabilities of the Arm, Shoulder and Hand (DASH), American Shoulder and Elbow Surgeons Score (ASES), Acromioclavicular Joint Instability Score (ACJIS), Subjective Shoulder Value (SSV), postoperative coracoclavicular (CC) distance, and reported complications. Risk of bias and methodological quality were assessed following Cochrane Review guidelines. Results Out of 1,885 screened articles, 12 studies met the inclusion criteria. The meta-analysis revealed statistically significant advantages of early surgery in terms of Constant score (MD: 5.9; 95% CI: 2.2–9.7; P < 0.01) and VAS for pain (MD: −1.2; 95% CI: −2 to −0.3; P < 0.01). Other functional outcome measures, complication rates, and changes in postoperative CC distance showed no significant differences between the two treatment strategies. Conclusion Although statistically significant differences favoring early surgery were observed for the Constant score, none exceeded the minimal clinically important difference. No clinically meaningful differences were identified between the early and delayed surgical management of high-grade ACJ dislocations in terms of functional outcomes, radiographic findings, or complication rates.